Provider Demographics
NPI:1194803528
Name:STROZIER, A MELTON JR (PHD)
Entity type:Individual
Prefix:
First Name:A
Middle Name:MELTON
Last Name:STROZIER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4947
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4947
Mailing Address - Country:US
Mailing Address - Phone:478-301-5930
Mailing Address - Fax:478-301-5932
Practice Address - Street 1:655 FIRST STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-301-5930
Practice Address - Fax:478-301-5932
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000493941BMedicaid
68BBDZMMedicare ID - Type Unspecified
S38142Medicare UPIN